Systemic Disease and the Liver Part 2: Pregnancy-Related Liver Injury, Sepsis/Critical Illness, Hypoxia, Psoriasis, Scleroderma/Sjogren's Syndrome, Sarcoidosis, Common Variable Immune Deficiency, Cystic Fibrosis, Inflammatory Bowel Disease, and Hematologic Disorders
The liver is involved in many multisystem diseases and commonly may manifest with abnormal liver chemistry tests. The liver test perturbations may be multifactorial in nature, however, as patients are receiving many different medications and can also have intrinsic liver disease that may be exacerbated by the systemic disorder. Some disorders have typical histologic findings that can be diagnosed on liver biopsy, whereas others will show a more nonspecific histology. Clinicians should be aware of these conditions so as to consider the performance of a liver biopsy at the most opportune time and setting to help establish th...
Source: Surgical Pathology Clinics - June 9, 2023 Category: Pathology Authors: Maria Isabel Fiel, Thomas D. Schiano Source Type: research
Primary Sclerosing Cholangitis, Small Duct Primary Sclerosing Cholangitis, IgG4-Related Sclerosing Cholangitis, and Ischemic Cholangiopathy
Pathologists face many challenges when diagnosing sclerosing biliary lesions on liver biopsy. First, histologic findings tend to be nonspecific with similar to identical features seen in numerous conditions, from benign to outright malignant. In addition, the patchy nature of many of these entities amplifies the inherent limitations of biopsy sampling. The end result often forces pathologists to issue descriptive sign outs that require careful clinical correlation; however, certain clinical, radiologic, and histologic features may be of diagnostic assistance. In this article, we review key elements of four sclerosing bilia...
Source: Surgical Pathology Clinics - June 9, 2023 Category: Pathology Authors: Katy L. Lawson, Hanlin L. Wang Source Type: research
Evolving Understanding of Noncirrhotic Portal Hypertension
Although cirrhosis is one of the most common causes of portal hypertension, noncirrhotic portal hypertension can result from hemodynamic perturbations occurring in the prehepatic, intrahepatic, and posthepatic circulation. Intrahepatic portal hypertension can be further subclassified relative to the hepatic sinusoids as presinusoidal, sinusoidal, and postsinusoidal. For many of these differential diagnoses, the etiology is known but the cause of idiopathic noncirrhotic portal hypertension, recently included in porto-sinusoidal vascular disease (PSVD), remains poorly understood. Herein, we discuss the diagnostic pathologica...
Source: Surgical Pathology Clinics - June 9, 2023 Category: Pathology Authors: Raymond A. Isidro, Lei Zhao Source Type: research
Evaluating Liver Biopsies with Well-Differentiated Hepatocellular Lesions
Needle core biopsies of liver lesions can be challenging, particularly in cases with limited material. The differential diagnosis for well-differentiated hepatocellular lesions includes focal nodular hyperplasia, hepatocellular adenoma, and well-differentiated hepatocellular carcinoma (HCC) in noncirrhotic liver, while dysplastic nodules and well-differentiated HCC are the primary considerations in cirrhotic liver. The first part of this review focuses on histochemical and immunohistochemical stains as well as molecular assays that are useful in the differential diagnosis. The second portion describes the features of hepat...
Source: Surgical Pathology Clinics - June 9, 2023 Category: Pathology Authors: Sarah E. Umetsu, Sanjay Kakar Source Type: research
Practical Guide, Challenges, and Pitfalls in Liver Fibrosis Staging
Liver fibrosis staging has many challenges, including the large number of proposed staging systems, the heterogeneity of the histopathologic changes of many primary liver diseases, and the potential for slight differences in histologic interpretation to significantly affect clinical management. This review focuses first on fibrosis regression. Following this, each of the major categories of liver disease is discussed in regard to (1) appropriate fibrosis staging systems, (2) emerging concepts, (3) current clinical indications for liver biopsy, (4) clinical decisions determined by fibrosis stage, and (5) histologic challeng...
Source: Surgical Pathology Clinics - June 4, 2023 Category: Pathology Authors: Karen Matsukuma, Matthew M. Yeh Source Type: research
Liver Pathology After Hematopoietic Stem Cell Transplantation
Hematopoietic stem cell transplantation is used to treat a variety of hematologic malignancies and autoimmune conditions. The immunosuppressive medications as well as other therapies used both before and after transplantation leave patients susceptible to a wide spectrum of complications, including liver injury. Causes for liver damage associated with stem cell transplantation include sinusoidal obstruction syndrome, graft-versus-host disease, iron overload, and opportunistic infection. Here, the authors review the clinical and pathological findings of these etiologies of liver injury and provide a framework for diagnosis....
Source: Surgical Pathology Clinics - June 1, 2023 Category: Pathology Authors: Ragini Phansalkar, Neeraja Kambham, Vivek Charu Source Type: research
Inflammatory Pseudotumor of the Liver
Hepatic inflammatory pseudotumor (IPT) describes a mass lesion composed of fibroblasts or myofibroblasts with a dense inflammatory infiltrate comprising lymphocyte, plasma cells, and histiocytes. These lesions are presumed to be an exuberant response to an infectious organism, although in most cases the causative agent is unknown. In specific circumstances, pathologists should consider ancillary techniques to exclude specific infections, such as mycobacteria, Candida, or syphilis. IgG4-related disease may cause a plasma-cell rich IPT. Finally, true neoplasms can mimic IPTs and must be excluded with appropriate ancillary st...
Source: Surgical Pathology Clinics - May 31, 2023 Category: Pathology Authors: Donghai Wang, Joseph Misdraji Source Type: research
Liver Pathology: Diagnostic Challenges, Practical Considerations and Emerging Concepts
With advancements in the diagnosis, surveillance, and treatment of medical liver diseases, the utility of liver biopsy has evolved significantly in recent years. In 2022, the primary purpose of tissue biopsy at the Brigham and Women's Hospital in Boston was to assess fibrosis stage (25%), autoimmune hepatitis or overlap syndrome (17.5%), fatty liver disease (14.2%), and cholestatic or hepatocellular liver injury with unknown cause (43.3%). Among the latter, many patients were suspected of having drug-/medication-induced liver injury, while some also had chronic systemic inflammatory disease. (Source: Surgical Pathology Clinics)
Source: Surgical Pathology Clinics - May 19, 2023 Category: Pathology Authors: Lei Zhao Tags: Preface Source Type: research
Navigating the Heterogeneity of Follicular Lymphoma and its Many Variants
Follicular lymphoma (FL) is a lymphoid neoplasm composed of follicle center (germinal center) B cells, with varying proportions of centrocytes and centroblasts, that usually has a predominantly follicular architectural pattern. Over the past decade, our understanding of FL has evolved significantly, with new recognition of several recently defined FL variants characterized by distinct clinical presentations, behaviors, genetic alterations, and biology. This manuscript aims to review the heterogeneity of FL and its variants, to provide an updated guide on their diagnosis and classification, and to describe how approaches to...
Source: Surgical Pathology Clinics - May 5, 2023 Category: Pathology Authors: Abner Louissaint Source Type: research
Hematopathology
SURGICAL PATHOLOGY CLINICS (Source: Surgical Pathology Clinics)
Source: Surgical Pathology Clinics - May 5, 2023 Category: Pathology Authors: Aliyah R. Sohani Source Type: research
Copyright
ELSEVIER (Source: Surgical Pathology Clinics)
Source: Surgical Pathology Clinics - May 5, 2023 Category: Pathology Source Type: research
Contributors
JASON L. HORNICK, MD, PhD (Source: Surgical Pathology Clinics)
Source: Surgical Pathology Clinics - May 5, 2023 Category: Pathology Source Type: research
Contents
Aliyah R. Sohani (Source: Surgical Pathology Clinics)
Source: Surgical Pathology Clinics - May 5, 2023 Category: Pathology Source Type: research
Forthcoming Issues
Liver Pathology: Diagnostic Challenges, Practical Considerations and Emerging Concepts (Source: Surgical Pathology Clinics)
Source: Surgical Pathology Clinics - May 5, 2023 Category: Pathology Source Type: research
Systemic Disease and the Liver-Part 1
The development of liver dysfunction in patients having various systemic diseases is common and has a broad differential diagnosis, at times being the initial manifestation of the disorder. Liver injury associated with systemic lupus erythematosus is heterogeneous and may present with nonspecific histology. Differentiating autoimmune hepatitis from lupus hepatitis is challenging on histologic grounds alone. Other systemic diseases that may present mostly with nonspecific findings are rheumatoid arthritis and celiac disease. More recently COVID-19 cholangiopathy and secondary sclerosing cholangitis have become increasingly ...
Source: Surgical Pathology Clinics - May 3, 2023 Category: Pathology Authors: Maria Isabel Fiel, Thomas D. Schiano Source Type: research
